In recognition of American Heart Month, we sat down with cardiologist Dr. John Pearson to discuss the ins and outs of heart health.

Roughly half a million Americans die each year from heart disease, the No. 1 killer in the country. But those numbers are dropping, said Dr. Pearson.

Q: Can you explain the difference between good and bad cholesterol?

A: Good cholesterol is known as HDL [high-density lipoprotein] and bad cholesterol is LDL [low-density lipoprotein]. HDL helps transport cholesterol away from your blood vessels so you don’t accumulate as much in your vessel wall. The higher your LDL, the more likely you are to accumulate cholesterol plaque in your arteries. The goal is to keep your HDL high and your LDL low.

Q: How is that done?

A: Niacin has been shown to raise HDL, but in most recent studies, though it raised HDL, it didn’t necessarily reduce the risk of heart attack or stroke. Pharmaceutical companies are working on drugs to raise it, but they haven’t been tested. Exercise, weight loss and moderate amounts of alcohol can raise HDL.

Q: How does a glass of red wine a day affect the risk of heart disease?

A: The data has suggested it’s not the type of wine. Alcohol in moderation can raise HDL. In most studies, people who drink a moderate amount of alcohol live longer than those who drink to excess or don’t drink at all.

Q: What effect does an aspirin have on heart health?

A: Aspirin affects the platelets in your blood, making them less likely to stick to a surface and create a clot. Say you have a blocked artery in your heart and the surface where you have plaque gets disrupted . Your platelets think it’s a cut and they have to heal it. So the platelets attach and release substances that make a clot. This shuts off the artery and you have a heart attack. So if you take aspirin, the platelets tend to just slide by and not cause trouble.

Q: What are some common risk factors for heart disease?

A: Smoking, diabetes, high blood pressure, high cholesterol, family history. There’s also been a tremendous amount of data that show people who exercise have a lower risk of heart disease, stroke and cancer. Almost everything is better if one engages in routine exercise.

Q: What’s the connection between obesity and heart disease?

A: Everyone has seen, particularly in certain states and certain parts of the country, a trend toward obesity, and many times that then leads to other problems such as hypertension, diabetes, inactivity. Your risk factors just keep piling up.

Q: Is there a correlation between stress and heart disease?

A: There is. One of the more extreme examples is takotsubo syndrome, also known as broken-heart syndrome, seen primarily in women. It occurs when a patient has suffered a severe emotional shock. They can have what looks like a heart attack — their heart stops functioning appropriately, and, many times, if you inject dye into their arteries, the arteries are fine. These patients usually get better. It’s felt that it’s probably due to stress causing the body to release substances like epinephrine that induce spasms in the arteries, leading to the mimicked heart attack.

Q: What pharmaceutical options are available for heart health?

A: The statin drugs — Simvastatin, Lipitor, Zocor and Crestor are the main brand names — are very good at lowering bad cholesterol. It has been shown in multiple studies that for patients who are at risk or have known heart disease, those drugs reduce the risk of further heart attacks, bypasses and stents, and they also increase survival. They’re interesting drugs. We know they lower cholesterol but they do other things as well. Primary prevention is just huge today. Medicinal advances have made a tremendous difference, and that’s just in the heart attack realm.

Q: And in the spirit of American Heart month, why is it important to learn how to take care of your heart?

A: So many people who develop heart trouble get into trouble over many, many years, not overnight. They may have a heart attack, but that took many years of building up cholesterol, having high blood pressure or diabetes. It’s important for people to understand that it’s like making an investment. The rest of your life will be better, you’ll live longer and you’ll feel better if you follow certain guidelines early on. It becomes a lifestyle.